Antidepressants

Drugs used to treat clinical depression, a medical condition characterized by long-standing feelings of sadness, apathy, and hopelessness. People with diabetes are especially prone to depression: By some estimates, 15% to 30% of people with diabetes may suffer from depression at any given time. Depression may worsen diabetes control by making people less active and less vigilant about their diabetes care.

Many people feel “down” or “blue” some of the time, but sadness that lasts two weeks or more or interferes with a person’s ability to carry out daily tasks or to enjoy formerly enjoyed activities are signs of depression, in which the brain is not functioning properly. Other signs of depression include having insomnia or sleeping too much, loss of appetite and weight loss (or eating too much and gaining weight), and lack of energy. Since depression can be debilitating and carries the risk of suicide, it should be considered a serious condition. If you experience symptoms of depression, be sure to consult your health-care team.

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In certain cases, antidepressants may be warranted, and health-care professionals now have a number of different types of antidepressants to choose from. One of the first types of antidepressants, which became available in the late 1950’s, are the tricyclic antidepressants, which include imipramine (brand name Tofranil), amitriptyline (Elavil, Endep), nortriptyline (Pamelor), and desipramine (Norpramin). These drugs are as effective as the newer antidepressants but have more unpleasant side effects, which include dry mouth, constipation, bladder problems, sexual dysfunction, blurred vision, and drowsiness.

Another older type of antidepressant, monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate), can benefit people with depression who aren’t adequately helped by other antidepressants. The side effects of MAOIs include restlessness, insomnia, weakness, drowsiness, dry mouth, nausea, diarrhea, and constipation. Certain foods, beverages, and medicines may interact in dangerous ways with MAOIs, so people must be carefully instructed in their use.

If it seems as if more and more people are taking antidepressants, this may reflect the fact that many of the newer antidepressants have fewer or less pronounced side effects than the older ones. Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa), work primarily on a neurotransmitter, or chemical nerve messenger, called serotonin. SSRIs work as well as the older antidepressants but have fewer side effects. Other new (non-SSRI) antidepressants include venlafaxine (Effexor), nefazodone (Serzone), and bupropion (Wellbutrin). Side effects of these newer drugs include sexual problems, headache, nausea, nervousness, and insomnia.

It generally takes six to eight weeks for antidepressants to start to work. The effectiveness and side effects vary from one drug to another and from one person to another, so part of the health-care professional’s job is to tailor the choice of antidepressant to the individual.

If the antidepressant you’re taking seems ineffective after eight weeks or has unpleasant side effects, your health-care provider may change your dose or start you on a different antidepressant. Never discontinue an antidepressant without consulting your health-care team: In most cases, the dose must be tapered down gradually and carefully to avoid withdrawal symptoms.

This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management.

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